After I was hired as the manager of a morgue in a major Washington-area hospital, one of my first goals was to organize and dispose of all the old amputated limbs that had been piled haphazardly in the cooler. The limbs had been amputated for many reasons—diabetes, infection, tumor, car accident—and they all ended up in surgical pathology. After the limbs had been dissected, they were put in the morgue, to be disposed of on a designated date. I discovered that the disposal date had come and gone for many of these limbs—some were as much as six months past due.
I burrowed through boxes upon boxes of severed legs and arms, some of which had not been properly wrapped and were bloody, softened, and fetid. Even though the cooler is chilly—a live person can stand in there for 10 minutes at most—natural processes continued to run their course on the body parts. They were swarming with shiny white maggots, which, fed by soft tissue and fat, were heartily multiplying. I stifled my initial urge to vomit, put on more fluid-proof Tyvek coverings, double-bagged each putrid limb in red biohazard bags, and sent them in cardboard boxes to be incinerated.
I’ve come a long way since I saw my first dead body when I was 19 years old. As a pre-med undergrad, I had an opportunity to view an autopsy at a medical examiner’s office. A car-accident victim, not wearing his seat belt, had been propelled through the windshield and had died from multiple compound fractures and ruptured internal organs. The exposed anatomy of his body seemed like something a normal, completely stable person would never want to see. But I loved the entire experience, from exploring the bloody wounds to learning about the strange tools used during an evisceration.
From that first day in the autopsy room, I was hooked on anatomy—hooked to the point that I researched careers in pathology. Most of my friends and family thought I was unusually morbid to want to work with the dead in the basement morgue of a hospital somewhere. I tried doing the usual volunteer thing the other pre-med students did—working at clinics with patients, listening to their concerns. Sure, I wanted to help people, but I didn’t have the patience to listen to them, and I felt I didn’t have the human interaction skills to continue with live people. To put it bluntly, I preferred to help dead people.
Today, I am in my mid-20s, well-educated, and well-acquainted with the world of death. I consider my morgue job interesting and exciting—very different than most boring office jobs. But it is still just a job, with the same kinds of responsibilities as any other. It’s certainly nothing like CSI: Crime Scene Investigation, in which any criminal can be caught by a pathologist using impossible gadgets and futuristic techniques. In my experience, pathology and forensics are very separate fields that rarely come together.
Though I manage the morgue, I don’t go inside it every day. The more time-intensive part of my job is dissecting surgical specimens in the pathology grossing room. Only about three days out of the week does the morgue require my attention. The full-time morgue attendants check in with me daily to update me on any issues that need my immediate attention; otherwise, I leave the bodies alone.
Still, I am responsible for knowing who and what is in our cooler. I become familiar with the bodies I see on a weekly basis, including those that seem to take up permanent residence in the cooler because no next of kin can be located. In these cases, there is no funeral or wake to plan, and these orphaned bodies might stay in the cooler for months. One man had been in there for such a long time, unclaimed, that a fine, white fuzzy mold started to grow on his face. I alert the decedent-affairs office within the hospital about these bodies, and we create a sort of trade with the local medical examiner. It works very nicely: The examiner’s office picks up the body in exchange for a $150 check taped to the sealed and labeled white body bag, and, in this manner, we control the number of bodies that our small morgue cooler can contain.
Part of my job is to keep the morgue and the adjoining autopsy room well stocked, so I’m always ordering supplies. I buy a lot of the instruments at the ultimate supply room—CVS. Among the Stryker saws, scalpel blades, and rongeurs are dressmaker’s rulers (to measure the crown-to-rump length and the circumferences of the chest, head, and abdomen in baby autopsies), plastic spatulas (to pick up and arrange brain slices in order to present the pathological findings), and a pink cigarette lighter (to sterilize chunks of organs still in the body cavity in order to determine what bacteria are growing in a cadaver’s lungs, heart, and other organs—and to add some flair to the autopsy room, which is otherwise filled with shiny metal tools). Other items, of course, need to be ordered from special supply houses, such as the six white I-shaped headrests used to elevate the head while opening the skull in order to remove the brain. The morgue attendants later told me that white is a poor choice of color for the headrests—blood, bone dust, and hair show up brighter and coarser against a bone-white piece of plastic. I guess that when these headrests crack and wear out, I will order them in black.
Last week, I had to cover the main pathology-office phone line while the secretaries went to an emergency meeting. I happened to answer a call from a kid, maybe 12 years old at the oldest, who was standing outside the morgue, calling from the phone mounted on the wall. He asked if he could speak to someone about a body in the morgue. I answered that he was talking to the correct person, me. The kid then asked if I knew where his mom was. He asked me, matter-of-factly, if I knew of any “Jane Does” in the morgue cooler that might be his mom. Surprised, I answered that he should try the admitting office, where records are kept of everyone—living and deceased—who has come though the hospital. I knew that we had no Jane Does in the morgue; most unclaimed bodies in the cooler are John Does. The confused boy did not even seem to think that his mom could be alive; he went directly to the morgue, he said, because that is where he always thinks his mother is going to be when he can’t find her.
In the cooler, we can hold about 21 bodies at maximum capacity. There is not much room, so in an effort to best use the space that is available, each body is carefully lifted using a pulley system onto its own “rack.” Each rack is essentially a giant, stainless-steel shelf with a little hole at one end to drain any escaping body fluids. It even comes with a small stopper on a chain to plug into the drain, in case a particularly juicy body overwhelms the capacity of the rack.
There are certain rules to follow when moving the bodies—rules that I have unfortunately learned from mishaps when trying to place bodies on the shelves. Only one body can fit on a rack at a time (with the exception of cachectic cancer and wasting-disease patients). If the cooler is extremely full, which happens on holiday weekends, we can make two of these smaller bodies share the same shelf. But the racks can’t be trusted to hold overweight or bloated bodies at all. These get to stay on stretchers in their own corner of the cooler until they are released to funeral homes.
Sometimes, we accept people into the morgue minutes after their death, depending on whether or not the family has seen the patient. The fresher bodies are wheeled into the cooler on a stretcher provided by the operating room or emergency room, where they must sit for a few hours to develop rigor mortis. Trying to move a body from the stretcher onto the rack too soon is pointless, because a freshly dead body is wobbly; the body will shift like Jell-O when shoved onto the shelf. And it’s just too warm and close to the act of dying. The very idea that the person was breathing, smiling, and possibly talking just minutes or hours before makes me feel my own mortality with too much clarity. It is much easier to wait until the body cools down a bit—then it seems as though I’m moving an object and not another person.
In the morgue, we have a “viewing room” where, once upon a time, families could sit with their departed loved ones and grieve over the deaths. That room is no longer used. Several times, family members have fainted at the sight of a dead body. Fainting in a morgue is like taking a bath in a toilet; the morgue is cleaned with bleach, but it’s never quite sparkling clean. The general public does not realize that when people die in the hospital, they do not die in a clean, sterile manner. Most bodies are partially covered in blood, feces, vomit, and the myriad other substances we have inside us. What can be more traumatic is that the medical staff does not take out the IVs, triple-lumen catheters, thoracotomy tubes, gauze, needles, or endotracheal tubes after a person expires. These devices, and many others, are left in place for the funeral home to remove.
Because of an increase in fainting accidents, the hospital instituted a no-viewing policy about two years ago. Many bereaved families and nurses find this to be an insensitive rule, but there are good reasons for it. Most of the time, family members would refuse to leave the body so it could be taken back into the cooler. These days, I have to turn bawling family members away from the morgue door. Some become hysterical and difficult to remove when asked to say goodbye one last time at the funeral home instead.
But there are times that a family barely gets to say hello. Every day, a new tightly wrapped bundle is brought to us from Labor and Delivery (L&D) and recorded into an ancient, giant logbook that we use to record every body’s entry to and exit from the morgue. Infants and fetuses make up about 90 percent of the morgue population, perhaps due to their fragility. They are the children of moms who received no prenatal care, moms who are drug abusers, moms who have genetic diseases, and moms who were perfectly healthy, received the best care, and followed every rule to the letter.
L&D is known for its quick removal of dead babies to the morgue. In fact, it happens so fast that many times the mother does not even see the baby when it is born. After it is whisked away to the morgue, a hospital social worker contacts me so that the body can be re-released back to the parents for one last chance to see their child. Usually, there are so many babies wrapped up in the pink and blue blankets that I can’t remember them all.
Except for one: A few months ago, a baby died with cyclopia, a malformation that causes both eyes to fuse into a single giant eyeball in the center of the forehead, usually accompanied by a proboscis—an appendage of skin near the fused eye. I released the body to the care of a social worker, who brought it to the parents. I was worried that the parents might be upset at seeing their baby with such a monstrous condition, and I told this to the social worker. She returned with the body about an hour later and recounted the parents’ reaction to me. They had completely ignored the eye. Instead, they’d concentrated on fitting their child with special baby Nikes, which they had bought for their son to celebrate his birth. I paused. What I thought was a horrid, glaring defect had been nothing to the parents—they just wanted to say goodbye.
I went back to my daily tasks, such as determining what size body bags we need to restock—regular, small, and extra small—and deciding what detergent best disinfects blood and stomach contents, which can escape from tears in the body bags. I had to move on, disassociate myself from the eye, from the parents. It’s something I do every day—something I do well. When I leave the morgue, walk outside, and see the sky, I am stepping away from death and into life.CP
Art accompanying story in the printed newspaper is not available in this archive: Greg Houston.